This invention relates generally to a surgical clip. More particularly, it relates to such a clip suitably adapted to replace a suture knot during endoscopic surgery, as well as a method of applying such a clip to clamp a suture, and a device for accomplishing this method.
As medical and hospital costs continue to increase, surgeons are constantly striving to develop advanced surgical techniques. Advances in the surgical field are often related to the development of operative techniques which involve less invasive surgical procedures and reduce overall patient trauma. In this manner, the length of hospital stays can be significantly reduced, and therefore the hospital and medical costs can be reduced as well.
One of the truly great advances in recent years to reduce the invasiveness of surgical procedures is endoscopic surgery. Endoscopic surgery involves the use of an endoscope, which is an instrument permitting the visual inspection and magnification of any cavity of the body. The endoscope is inserted through a cannula after puncture through the wall of the body cavity with a trocar, which is a sharp-pointed instrument. The surgeon can then perform diagnostic and therapeutic procedures at the surgical site with the aid of specialized instrumentation designed to fit through additional cannulas providing small diameter openings into the desired body cavity as may be required.
An age-old procedure which surgeons are required to perform to repair or reconstruct traumatized bodily tissue is suturing. Fortunately, medical instruments have been recently designed to allow a surgeon to manipulate a suture, or suture and needle combination, through the small diameter opening of a cannula. However, the ability to tie an appropriately placed suture knot has become troublesome and problematical.
Therefore, in response to this problem, surgeons have sought alternatives to conventional knot-tying techniques which would be suitable during endoscopic surgery. Among these alternatives include the use of hemostatic clips, which are designed to ligate blood vessels and other tubular members, to replace suture knots. Such hemostatic clips are described, for example, in U.S. Pat. Nos. 4,418,694 and 4,476,865. These clips can be readily applied with a clip applier which is designed to function through the small opening of a cannula. Unfortunately, the force required to displace these clips from the suture is inadequately low. As a result, hemostatic clips of the type shown in the art are unsuitable for general endoscopic surgery needs.
More recently, attempts have been made specifically to replace tying suture knots. U.S. Pat. 4,662,068 describes an apparatus which performs the multiple functions of fusing adjacent suture strands together as well as cutting the strands after the fusing operation is performed. Unfortunately, such a device is unable to transmit to the adjacent suture strands an adequate adhesive force to prevent the suture strands from disengaging. U.S. Pat. No. 4,078,731 describes a suture clip which eliminates the need for tying suture knots. The clip is configured in such a manner which allows the clip to be manipulated into a first position which defines a complete passageway around the suture being threaded through the clip. Once the clip is placed adjacent to desired bodily tissue, the clip is manipulated into a second position for clamping the suture. Although this clip can be designed to achieve adequate clamping force, unfortunately the overall design of the clip requires delicate fabrication which can lead to practical difficulties.
In view of the deficiencies of the prior art for creating a useful alternative to tying a suture knot, what is desired within the medical community is a clip and a method for applying the clip using endoscopic techniques which can successfully replace the suture knot. In addition it would be helpful if a suitable clip applier were developed which could be used in conjunction with such a clip and the method for applying the clip.